When Patient Experience Meets Quality of Care: Brian Carlson

When Patient Experience Meets Quality of Care: Brian Carlson


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About Brian Carlson

Brian Carlson currently serves as Vice President of Patient Experience for Vanderbilt University Medical Center. Brian joined Vanderbilt in 2007 as Administrator of the Vanderbilt Eye Institute. Prior to Vanderbilt he served as CEO/COO of a multi-specialty physician group practice in Western New York and started his professional career at Northwestern Medical Faculty Foundation in Chicago.

In his current role, he is strategically and operationally responsible for institutional performance on service programming and metrics. Operationally he has direct oversight to Guest Services, Patient Relations, Service Consulting, Physician Liaison and Center for EMS Excellence. Strategically he advises on institutional goals, employee engagement, culture, and patient engagement programs, including online patient portal My Health at Vanderbilt.

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Mary Drumond (00:00):

So here we are back once again on season five of Voices of Customer Experience podcast. And today I am joined by Brian Carlson who works at the Vanderbilt University medical center and he is here today to talk about patient experience. Hey Brian.

Brian Carlson (00:18):

Hello. How are you?

MD (00:19):

Thanks so much for coming on today. I’m really excited about doing this and I know that PX is such a big topic and we get so many requests to create more content on it. So you being here is really providential for our listeners.

BC (00:33):

Oh, that’s great. Well, it’s an honor to be here and thank you for having me.

MD (00:36):

Well, I wanted to start off by kind of explaining the clear differences between like customer experience in general as we see it and patient experience, PX. So the difference between CX and PX. Can you give us a little rundown?

BC (00:49):

Yeah. From my perspective. So, at a base level, it’s experience. And the way I think about experience, it’s any and all interactions that we have with a system, with an organization, with a person, and it’s highly unique to us. So, you know, that’s similar between the consumer and the patient space. What’s also similar between the consumer and this patient space is that there’s various different avenues that we interact with those systems. But what’s different is on the patient experience side, so much of it and success in it relies still upon the human interaction that people have a problem and they want to feel like they’re being taken care of. And it’s listening. It’s communication, it’s empathy, it’s compassion, it’s all of those things. And that’s not to say it’s not in the consumer space because certainly it is, but it’s so much more part of healthcare. That’s who we are. Well, that’s what we deliver. So that’s the way I think of a difference between the patient and the consumer space.

MD (01:49):

It’s interesting because I would say that one of the strongest issues that must arise for you who deals in this industry is how delicate it is as opposed to in customer experience where people are just doing regular transactions on a day to day basis. In this case, I mean you could have people that are just going in for checkups, etc., But in many cases it’s people’s health. It’s people’s lives. So you have not only anxiety and nervousness and fear, but there’s so many strong emotions that kind of surround this experience, right?

BC (02:25):

Mhm, absolutely. You know, any conversation experience in the patient space, you have to acknowledge the incredible work of the physicians, the nurses, the direct care providers that do it day in and out. But it takes a true team to do it. And that’s where it gets complex because the point of entry is so varied in how a person will enter the healthcare system, and we have to meet them where they are and some people are healthy and well and they, you know, are willing to wait and may be patient. There’s others that don’t feel well and they want to get in as soon as they can and know what’s going on. There’s others who have a chronic condition that they have to unfortunately live with and their needs are very different. So the challenge is when we started kind of trying to map out and understand these experience journeys is, it’s highly unique and highly personalized. And that’s what makes me really proud here at Vanderbilt, one of the things that we’re focusing on pretty heavily as this is this term defining personalized care. And what is that? And it’s a hard definition because it’s personalized and personalized means it’s unique to me. And what’s unique to me is maybe not unique to you or what you care about.

MD (03:28):

Yeah, absolutely. And as, as you were saying that my mind was kind of thinking here, where you were talking about different points of entry. So you know, when you have people that have emergency care, for example, and what you have to do is, you know, stabilize them, make sure they’re okay in some cases even save their lives, right? But when you’re talking about people with chronic illnesses or longterm treatment, there’s almost a loyalty factor. Like I don’t want to be disrespectful cause it sounds so weird when we’re talking about people’s health and people’s lives, you know, but you almost have to look at it in terms of loyalty, right? To have those people keep choosing you over and over again. Right?

BC (04:06):

Absolutely, yeah. And even on that scale, there’s a difference because there’s chronic conditions that you can improve on and make strides to. And there, your experience could be dictated by the skill and the expertise. Are people listening to you? Do you feel like you’re advancing? There’s other ones where it’s maintenance and you know, you’re a frequent flyer so you see us a lot, but you could maybe go anywhere to get it taken care of or be seen. So your threshold could be lower in terms of deciding, you know what, I’m going to, I’m going to look somewhere else for, uh, for taking care of this. And then there’s a whole other avenue that gets into the world of second opinions in the healthcare space. And that’s kind of a shopping, you know, I heard this over here and now I want to go over here. And that’s where brand strength really comes into play. And the strength of not only the brand, but that brand is grounded and the expertise and the excellence of the providers that work at that system and their ability to deliver on that care.

MD (05:10):

That kind of boils down to trust, doesn’t it?

New Speaker (05:13):

It does. Absolutely.

MD (05:15):

So the trust that patients have in the healthcare providers and the whole system actually, right?

BC (05:20):

Yeah, absolutely. So it’s interesting. Yesterday I had a colleague tell me they are in the market for a new primary care physician. They’ve been kind of shopping and access can be limited in primary care, dependent on locale, where you live. And here in Nashville we have some of those issues that, you know, there’s more people than there are primary care in some cases. So they had been shopping around, and I asked him, well, what’s important to them? And they said, well, it’s interesting because that’s changed for me over the course of time that now, you know, what I want is I want to know that I going to have the same person because they had an experience where it was a lot in the past and that I can get in when I need to get in. But most importantly, do I like them? Do I trust them? Do I have a rapport and relationship with them or is it simply transactional and I’m going to tell you what to do and maybe listen to you and maybe not listen to you. And that’s where the experience realm really comes into play, that it’s not just about that technical expertise, but it’s also that empathy and compassion side to listen and say, I’m here to help you. What can I do for you?

MD (06:25):

Yeah. Let me ask you something, ’cause I know that you also go to a lot of customer experience events. What sort of challenges do you face in the healthcare industry specifically, being that it’s so highly regulated?

BC (06:38):

Yeah, so probably the biggest thing that we faced is the ability to share data and share data in a way that is very easy to share that data. So depending on where you go, yes, that data is mine as the patient, but it’s under the auspices of the institution I’m being seen at. And I have to go through the efforts to get that data if I want to go somewhere else. And healthcare is about a story. It’s not just one episode, we grow over time. Things happen to us. And there’s a progression to that. So it’s bigger than regulations. We just don’t have a good mechanism right now to share data about both the experiences and the clinical care of patients. It’s there, but it’s complicated.

MD (07:24):

When it comes to analyzing patients’ experiences and their decisions to choose one healthcare provider or not. You and I have talked about this before, Brian. You know, I strongly believe that there are all these elements of human behavior that help form that decision. Drivers, right, that actually play in people’s minds and help them make the decision with, there are a lot of different elements that come into play. So, you know, there are a couple of traditional ones that we talk about when we’re discussing customer experience. Well, what do you feel in your experience are some of the strongest drivers of patient experience? A positive patient experience or negative one? So, you know, you talked a little bit about trust, right? Trust is probably a huge driver. It’s definitely something that impacts customer’s experience or patient’s experience with their healthcare provider. What are some other ones that we can kind of outline?

BC (08:20):

Well trust is something that you have to build with time. You know that some people, it’s there, others you have to grow it and how do you grow that trust? But I think those are where some of the behaviors that come into play, in the healthcare space, and of course this is unique to the various systems. So I’m going to speak now just at the outpatient or the provider level. What are driving people? Am I being listened to? Are the providers, the nurses, the staff, are they valuing me as a part of the care team and listening to the story I’m telling and what my wants and needs are and meeting me where I’m at or is it just, yeah, I know what this is, do this,. take my advice, go do it. And I think that’s where we, in healthcare, have had to learn, going from this kind of paternalistic system of we know what’s best, to first asking the question, tell us about you, tell us what your problem is and how can we help you? And then molding in so the patient feels like they’re listened to and they’re communicated with. So communication and listening are two huge, huge factors. And I would say that’s across any part of the healthcare system, not just the outpatient space.

MD (09:32):

How much do facilities play into a good experience or a bad experience?

BC (09:39):

You know, it’s interesting. There’s different studies out there on this and I’m going to go through my lens on what I hear from patients. Certainly the comfortability of a facility can have an effect, but, the big but on that is they’re willing to have maybe substandard facilities if the expertise of what they’re seeing is going to help them get better. So if I have a problem and I want to go to the best, I’m willing to maybe let go of the 1950s feel of the place, or it’s maybe a little run down, if I know the expertise is going to help me get better. But that being said, a lot of conditions these days are more transactional. It’s I just need an update, I need my medicines filled, I need that. And that’s where facilities do come into play. And from that perspective, it’s really more where the facility’s at. Is it convenient for me? Because, yeah, in metropolitan areas like here in Nashville, traffic is hard. It’s difficult. And can I spend an hour of my day, two hours of my day fighting traffic to get to the doctor’s office to be seen and then go back or do I want to go something really close that I know I can get in and out real quick? So we think of this, we think in terms of is it locale now, is it near? And of course you want updated facilities as well.

MD (10:56):

Do you think, well I’m sure it does, but how much does wait time play in? Is that a big challenge that you guys face?

BC (11:04):

Yeah. Um, yes. And I think a lot of institutions, and I hate it. We all hate it. We don’t want to make our patients wait. Part of that is just the economics, that the volume, what we’re trying to see and take care of, exceeds the capacity of what we can do in a period of time. So we want to do as much as we can, but then that can get backlogged, right?

MD (11:27):


BC (11:28):

What I find though is it’s shifting a little bit, but by and large, we are willing to wait if we’re kept informed, which shows respect.

MD (11:40):


BC (11:40):

Yeah. It shows that I respect your time, that you’re a professional, you’re busy, I’m busy too and I’m going to keep you informed and let you make a decision, you know what, I can’t wait any longer. I’ve got to get to this and I’ve got this or I’ve got to go pick up the kids or whatever. Whatever’s going on in life at that period of time. So yeah, the thing we talked about is really keeping patients informed about those delays. And we find that if we do that people are willing by and large to wait. They know it’s part of the equation. There’s another part to that. And that’s expectation setting. I think this is a space in the healthcare arena that we can always get better at. It’s setting the right expectations. And I will frequently reference, you know, people can get sideways with me on this when I reference the restaurant industry, cause it’s not like healthcare, but what restaurant industries have figured out very well is how to manage the expectations. How often do you go to a restaurant and they say it’s going to be 30 minutes and it’s actually 45 minutes these days? My experience is not very often.

MD (12:40):

They do the opposite, right?

BC (12:40):

It’s actually opposite. They’re telling you 30 but it’s actually 15. So all of a sudden you’re thinking, I’m going to sit here for 30 I made a decision and then surprise, guess what? We’re ready to take you back, and it’s 15 minutes. That’s something we have not quite embraced yet in the healthcare space of delivering on that expectation setting, where we set it, I guess we set it low and deliver high, right?

MD (13:07):

You know, this is so fascinating for me because it really goes along with what I always talk about, which is that it’s all about how those drivers weigh out for the customer at that moment. So if you have a lot of trust in your healthcare providers, the other drivers will be less relevant or less important or have less impact on the decision. Whereas, you know, I always talk about this with restaurants and we’re going back to restaurants once again, but like, so me personally, I will go to a place that has like really good food, okay? And if the service is crappy, I mean it’s really hard for me to go back to that place.

BC (13:48):

It is, isn’t it?

MD (13:48):

Unless like you said, my expectations were really low. So if I was, and that reminds me of, I dunno if you were a fan of Seinfeld back in the day.

BC (14:00):

I was.

MD (14:00):

It reminds me of the soup Nazi. You go and get that soup. And the soup is so amazing that you put up with this horrible, horrible service because you want that soup so much, you know? But if the food is just normal, you will definitely not put up with bad service. So everything depends on how each situation plays out with those decision drivers. And the exact same thing is happening in, in healthcare. But, changing the subject really quick, we know for a fact that customer experience has a lot to do with employees and employee experience and how employees not only interact with the company, but how empowered they feel to actually help the customers. I’m pretty sure that this is a big factor when it comes to PX as well.

BC (14:53):

Oh, it’s at the crux of it. It is the crossroads of it. I mean, I will tell people we are in the business, our product in healthcare is managing human capital. That’s our product. Think about it. Most everything we deliver relies upon humans to deliver that. And anytime you put humans in an equation, it can become very complex real quick. And there’s so many individual factors that play into that. So when you rely on humans to deliver that service, they have to feel like they’re part of something bigger than them, that they belong to it, right? And that they’re making a difference. Their contributions are making a difference. And what other industry can say, other than healthcare, that you are making a difference. You are truly making a difference in someone’s lives. And I tell people, even if you’re not in direct patient care in healthcare and you work in, you know IT or billing or any backend functions, you’re one removed. You’re part of the team that is helping those direct care providers. So if you can make their job a little easier, you can guarantee that it’s affecting a patient somewhere along the line. But that engagement and that employee experience is so vital because we have issues right now in the healthcare space of burnout of wellness. It’s exhausting. You go home and you’re tired and you got to get up the next day and you gotta put yourself back in the frame of mind, I’m here to serve. I’m here to help people. But there’s days where you just don’t feel like it. And I don’t know about you. But me, when I don’t feel like it, I’m not on my A game and I think others around it are going to feel that. So if I’m a direct care provider, I’m not having a good day. Guess what? People are picking up on that and it’s not just the patient’s in the room, it’s also the staff that work around the work you work with. Cause it’s a true team sport.

MD (16:41):

And you’re so right that the level of human interaction in the healthcare industry is so strong because you can’t really replace any of those roles with machines or chatbots or whatever.

Speaker 2 (16:54):

Well we’re trying, I mean there’s a lot going on in that space yet to be seen if it actually can make a difference or not. But yes.

MD (17:00):

You have to have some pretty cool robots to do that. But, it really is. Do you think that training is key when it comes to that? Because lots of times when you have like exhaustion or you know people have bad days, but ultimately if we can kind of default back to almost like where you going to like auto mode, if there’s like really solid training I think that even in our worst days–I could be wrong here. I don’t work in healthcare– I think that even our worst days if we can default to our training and it’s really, really strong and always striving to be just really, really human. I think that that’s very helpful.

BC (17:42):

Yeah, so I think of that a little differently. Yes, training is is key and yeah, that experience that we have of see doing one and you grow confidence in it, you can go back on that and that really helps you. But when you think of interactions, and you think of if I’m having a bad day, is my training really going to, if I go back and center myself on that, is that going to improve the next room I walk into? Well maybe, but I would hypothesize what actually is going to make it more so is the effect that people you work with around you have on that, the teams you work within. There’s a lot, we expect people and so you come in, you get all this clinical training and this tactical training, but we’d need to spend more time on the human side of it. We expect us just to work just to naturally understand how to work in teams, but it’s amazing the number of times when I talk to different teams, they don’t even know each other. I mean they know their name, but they don’t know about them personally and here I am relying on this person to do their job and jump in. If you think of the most effective teams, it’s I have your back and you have my back, right? Yeah, yeah. The most effective teams in healthcare, those are the teams that have that, but not every team does. So training is a part of that, but there’s also focus time that needs to be given on developing teams in the healthcare space. Because it is, like I said earlier, it is a true team sport.

MD (19:14):

That’s awesome. Another question, just kind of following up on that same topic, how often do you see that healthcare providers, since they’re so close to life and death, and I imagine it’s really difficult, it really takes an emotional toll to be so involved in such a vulnerable moment of life. Does it happen more often than not that people get cold or get used to it and seem to deal with it in a more matter of fact way than it should?

BC (19:51):

So the term we use for this is desensitization. They become desensitized because they see it so frequently and, and you have to remember that healthcare is broad and there’s a lot more living than there is dying. Thank God. So there’s a lot more wellness and caring going on then there are unfortunately people passing away. But it does happen. That’s life, right? But that passing can be narrowed down to different segments within the healthcare system. And those teams, that’s where they have to rely upon the true essence of the people they work with, the social support, emotional support around them being at home or in the workplace so they don’t become too desensitized to it, that they have time to decompress and get away. So emergency departments, surgical areas, ICUs, cancer, palliative care, you know, those are the ones that come to my mind where those teams are dealing with it more frequently, where they see the really unfortunate part of human nature of someone someone passing on. And can they become a little desensitized? Yeah, maybe. But I think that they are professionals and they come to do their job and they come to do it very well. What fills their cup is that knowing that the next patient in the room still needs their help and their outcome is going to be good and they have a team that they can rely upon to help them. Makes sense?

MD (21:12):

Yeah, absolutely. And that’s great. Now moving into the technical aspect, which is the part where you need to actually look at numbers, look at metrics, try to find new ways, map the patient journey, be creative in how to improve that patient in spirits. What are you doing and what is the organization that you work for, how are you working together to improve patient experience?

BC (21:39):

Yeah. Well the first thing I’ll say, and this is broad. We have no shortage of data. We have plenty of data. We have more data than sometimes we know what to do with. So our insights can be very deep. The challenge we have is getting our arms around it because they can be varied and they can come at so many different the avenues and angles and inputs. So for me, it starts with narrowing down what is our goal? You know, what is our common purpose in this? And in the patient experience that is putting the patient first in a very just kind of matter of fact, pure way. The patient is first. So if you take that perspective and we’re doing everything we can to help that patient, how does their experience translate to the other patients we see and what can we learn from that? This is where data gets complex because every person’s experience can be a little different. Their expectations can be a little different. So we’re looking for patterns, we’re looking for trends, we’re looking over periods of time, we’re benchmarking, you know, benchmarking’s big. Comparison. Ego plays into that a little bit, but it’s also to say, you know, finger in the wind. How do we compare? We’re average, we’re better than average or below average. And that gives us a sense. But to really do improvement efforts, you got to dig down in there and get down to the root of the patient level and really listen and hear the patient comments that we get, which we get thousands of them. And we’re so lucky that patients are willing to give us their time to give us that feedback. And to use those comments to try to put together a picture of is this experience wholly owned and wholly unique to this individual or is there circumstances of this patient’s experience that are replicated across others? And then how can we use that to make improvements so the next patient walking through the door doesn’t experience the same thing? And that can be on the system process side and it could be on the human side. Right? ‘Cause people are responding to both when they tell us about their experience.

MD (23:35):

What are you looking for? What sort of trends are you looking for in the data? Are there any KPIs that are in play?

BC (23:42):

Yeah. So we measure Topbox score here at Vanderbilt and in the consumer space, you know, some of the GoTo metrics are likelihood to recommend, overall quality of care. We tend to stay away from that because our vantage point is that’s one question, one response. And those questions are very powerful, don’t get me wrong, but it’s still one question, one response. If the experience of a patient is the sum of all interactions, then we need to take into account all of the questions we’re asking the patient feedback on. So we look, we take all the questions on our survey, we cumulate those to a top box score. How many times did we get that top box checked and we get a score on that. And then we aggregate that over across all our service lines and we land with one score. Now that goes all the way up to the top and then it comes back down cause you gotta re divide it out across the areas and started looking at, is this above average is below average, how’s it compared to their peers? Because every specialty is a little different in terms of comparison. T,here’s not one broad comparison across the health care space. So I think the common purpose is so important, but then taking the data and translating that to a score that then can be divided out of what does this score mean? So we’re getting a Topbox score of 70% on this, the 30% that’s giving us not Topbox our opportunity is in the space of facilities, is in the space of access, is in the space of you know, communication, and we ask specific questions on all those. And what I find is no two are alike. Every practice, every area is just a little different, a little unique in what’s going on with them, what they do, how they do it. It requires a lot of time and effort to figure it out. And then ownership. People have to look at the data and say, okay, I understand this. This is what my patients are saying. Is this unique or is there some systemic problem here that I can help so it improves it for other patients walking through the door later? Did I answer your question?

MD (25:40):

Yeah, you did. And one final question before we wrap up. How big a role would you say experience plays when it comes to the strategic decisions made by not only your organization but by the industry in today’s day and age?

BC (25:57):

I think there’s room for growth in there. Certainly experiences in the equation. It is part of the conversation. It is not the only thing though. And you know, many institutions are also marrying experience and quality, so outcomes, which makes a lot of sense. We want quality outcomes as well. The patients expect quality. They come in expecting that they’re going to get good clinical care. The experience side, maybe it’s a little more wide open, but I think that in the healthcare space we still have a lot of opportunity from the executive level on down a really understanding the effect the experience has on those outcomes. And there’s more and more studies that are showing that we can have good clinical outcomes, but if people don’t feel listened to, they don’t feel heard, are they walking away feeling as good as they could if they felt like they were in control and they were part of their team and that their care was 100% in their control? I would hypothesize no, that they would want more, right?

MD (26:57):

Yeah. Well this has been a great discussion, it has been fascinating for me to hear from the inside because I think this is the first time on this podcast that we have someone who practices this inside an organization giving us so much insight on what’s going on. So I wanted to thank you for coming on here today and I wanted to ask you, what are some ways, do you speak, do you write, do you interact in this space? How can our listeners communicate with you or follow you or ask you questions if they have questions on this episode?

BC (27:32):

Absolutely. So I’m on LinkedIn, obviously Brian Carlson from Vanderbilt University Medical Center. That’s a great way to interact. I’m trying to publish more and more on there in the, in the experience space. So there’s some writing on there specific to healthcare. I do tend to talk in the patient experience realms, conferences specifically for that, but I’m also trying to broaden and get out in the consumer space because there’s so much we can learn from the consumer space, just like I think the consumer space can learn from patient space, from healthcare space. And I think that my impression as a consumer is, so much is going digital and non interaction. Healthcare is still very much about that interaction and I think that pendulum is going to continue to swing over time and the consumer space is going to have to come back around to those human interactions that sometimes you just want to talk to someone. Sometimes you just want to feel like you’re being listened to and I think that’s where we can help and learn and educate the consumer space from the patient space.

MD (28:34):

That’s great. Brian Carlson, thank you so much.

BC (28:37):

Wait, I have one question for you. So you listen to all sorts of consumers talk. Listening to this, what advice would you have for us?

MD (28:50):

You know, from what I heard you talk about today, I think that if other people in the industry think like you and have access to the same tools and information that you have, I think that it’s setting a really good precedent or setting a really good track for the entire industry. Because if I think the healthcare industry as a whole listened more, paid a little bit more attention, valued that human connection a little bit more, gave more focus to these smaller details that you’ve been discussing for the past 20 minutes, I think that that would improve, at least my experience firsthandedly, that would improve immensely. And I definitely, definitely by far always prefer going to either at a doctor’s office or a hospital or any sort of healthcare facility where I feel respected as a human being, where I feel valued and where I trust in those healthcare providers to do the very best thing for my health and to look after me. So I don’t, I don’t really have anything to add to everything that you’ve said other than keep doing it. Keep building it. Give it more space. Listen more.

BC (30:08):

Talk about it. Discuss it.

MD (30:08):

Talk about it. Listen to your patients.

BC (30:11):

Employee engagement, all of that stuff. Absolutely. Amen.

MD (30:13):

Create patient centric culture in healthcare.

BC (30:19):

It is there, it is there. The patient is first, especially at the physician level, so.

MD (30:24):

That’s great.

BC (30:24):

Thank you so much. It’s been a great conversation.

MD (30:27):

Thank you. I really appreciate this. Awesome.

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Mary Drumond

Mary Drumond

Mary Drumond is Chief Marketing Officer at Worthix, the world's first cognitive dialogue technology, and host of the Voices of Customer Experience Podcast. Originally a passion project, the podcast runs weekly and features some of the most influential CX thought-leaders, practitioners and academia on challenges, development and the evolution of CX.



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